Spitzyna 2007.

Study characteristics
Methods	Compensative intervention versus control, placebo or no intervention Design: randomised cross‐over trial. Stratification: "Because of the small number of patients entering the study, we wished to ensure that the two treatment groups did not become unbalanced on a few key variables so patients were allocated using a modified minimization technique where cumulative measures of two factors (text reading speed (≤ 90 or >90 wpm) and degrees of sparing of right foveal/parafoveal (0 or 2 degrees) vision) were used to minimize the difference between the two groups." Randomisation sequence: modified minimisation technique: "The weighting used for allocation to the group with the lowest total was one. We describe the minimisation as modified because the first subject was not allocated randomly to either group, but deterministically placed in Group 1." Comparisons: "Two‐armed study with two therapy blocks in each arm: one group practiced reading moving text (MT) that scrolled from right‐to‐left, daily for two four week blocks (group 1), while the other had sham therapy (spot‐the‐difference) for the first block and then crossed over to MT for the second." Allocation concealment: personal communication with authors: "The allocation was concealed from the persons recruiting into the study but not from the tester. The recruiter(s) did not know that the first subject would be placed in group 1 but the tester did". Blinding: personal communication with authors: "The tester was the first author (a psychologist). She was not blind to the therapy. It was not possible to blind her to this as it was a behavioural therapy and she was 'dispensing' this at each time point." Power calculation: no Intention‐to‐treat analysis: no Other recruitment details: not stated Patient and public involvement: not stated
Participants	Total study population: 22 participants recruited, data for 18 Withdrawals: "three dropped out before completing therapy". Method of diagnosing VFD: "Perimetry was performed twice, before and after completion of the therapy blocks (B and T4). Static fields were measured using the automated Humphrey field analyser II (Carl Zeiss Group, California, USA) analysis of the central 10 degrees of vision (central 10‐2 threshold test). Dynamic fields were also measured using a Goldmann perimeter (Haag Streit, Köniz, Switzerland) when there were concerns over subject’s performance with the automated procedure (a false positive or false negative response rate greater than 15%). The procedures for determining the amount of field sparing were as reported previously. In the event of a discrepancy between the static and dynamic fields or pre‐ and post‐therapy changes, the opinion of the orthoptist who performed the tests (Ms Bronia Unwin) was sought. The precision of the static perimerty is two degrees and all the patients fell into one of two groups, either 0 or 2 degrees spared to the right of fixation." Characteristics of population: participant details are listed in Table 6. Type and severity of visual problems: participant details are listed in Table 7. Inclusion criteria: not stated, but described as "participants with fixed homonymous right‐sided visual field defect that interfered with reading (hemianopic alexia)." "All the patients had a fixed homonymous defect that had been present for at least 3 months". Exclusion criteria: not stated Baseline comparison of treatment groups: some discrepancies between baseline characteristics of groups. Length of time since symptom onset ‐ all participants in Group 1 were over 1 year since onset of symptoms; 4 participants in Group 2 were less than 1 year since onset (3 are 6 months or less). Average age at time of symptom onset was 43 years for group 1 (range 5 to 67 years) and 63 years for group 2 (range 39 to 78 years). "There were no differences between the groups on all of the variables" for general neuropsychological assessments. The study included a mixed population. This study included patients with visual field defect only (no visual neglect). Method of diagnosing visual perceptual problems: not stated
Interventions	Group 1: optokinetic nystagmus inducing reading therapy (n = 11) Intervention type: compensation Intervention: horizontal scrolling text from right to left to "induce small‐field optokinetic nystagmus" Materials: "The tapes were made by animating freely available text from a variety of Sherlock Holmes stories (www.citsoft.com/holmes3.html) across a computer screen from right‐to‐left (i.e. horizontal motion was from the patients’ blind field into their seeing field), so‐called Times Square presentation. After some minor preparations, such as deleting hyphens and adding a few spaces after each sentence, custom‐written software was used to animate the text across the screen at a variable rate. The output from the graphics card was connected to the video‐input on a VHS video recorder to produce the tapes. Tape speeds of: 85, 105, 143, 173, 205, 240, and 275 wpm were made with the text presented in Times New Roman font, 24‐point, black on white, scrolling across the middle of the screen." Where can materials be accessed? not stated. Procedures: participants were instructed to read and try to follow a line of text scrolling horizontally from right to left in the middle of a computer screen at speeds of 85 to 275 words per minute. "Patients were instructed to read the story on the tapes and try to follow it, although no tests of comprehension were made to check this." Provided by: not stated. Delivery: not clear. Patient‐led therapy. (Table 5). Regimen: "treatment blocks lasted for 4 weeks each" and participants were asked to record how long they spent on the tasks each day. "The aim was to achieve a minimum of 400 minutes of rehabilitation (20 sessions x 20 minutes) over approximately 4 weeks". Tailoring: "patients contacted one of us (G.A.S.) when they required a new (usually faster) tape." Modification: no. Adherence: "There were no differences between the two groups in total time spent on rehabilitation tasks across both treatment blocks in minutes (range), 914 (865‐955); 901 (840‐1000), t‐test, t (10) 0.50, P = 0.628". Group 2: control (n = 11) Intervention type: control Intervention: sham training; "spot the difference" Materials: "'Spot‐the‐difference' tests were taken from a children's puzzle booklet; the original cartoons were altered to remove text. The number of differences on each page varied between eight and 12." Where can materials be accessed? not stated. Procedures: "Patients were instructed to look for as many differences as possible between the two pictures, but were not told how many to expect, completing at least two cartoons over 20 min. Between 40 to 60 examples were selected randomly for each patient (out of a total of the 70 prepared tests), depending on their speed." Provided by: not stated. Delivery: not clear. Patient‐led therapy. (Table 5). Regimen: "treatment blocks lasted for 4 weeks each" and participants were asked to record how long they spent on the tasks each day. "The aim was to achieve a minimum of 400 minutes of rehabilitation (20 sessions x 20 minutes) over approximately 4 weeks". Tailoring: not stated. Modification: no. Adherence: "There were no differences between the two groups in total time spent on rehabilitation tasks across both treatment blocks in minutes (range), 914 (865‐955); 901 (840‐1000), t‐test, t (10) 0.50, P = 0.628"
Outcomes	See Table 8 Text reading speeds (passages from Neale analysis of reading) Single word reading speeds (words taken from MRC psycholinguistic battery) Eye movement characteristics ‐ spatial characteristics of saccadic amplitude, incoming saccade amplitude and landing position ‐ temporal characteristics Perimetry ‐ Humphrey field analyser ‐ Goldmann perimetry Time points when outcomes were assessed: T1, initial assessment; T2, before treatment; T3, after the first training component. (Additional time points ‐ after the cross‐over were: T4, after the second training component; T5, after a follow‐up interval)
Notes	Did not state whether visual correction using glasses was used during training or testing.
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	Modified minimisation technique of sequence generation. Personal communication with authors: "The allocation was concealed from the persons recruiting into the study but not from the tester. The recruiter(s) did not know that the first subject would be placed in group 1 but the tester did".
Blinding (performance bias and detection bias) All outcomes	High risk	Personal communication with authors: "The tester was the first author (a psychologist). She was not blind to the therapy. It was not possible to blind her to this as it was a behavioural therapy and she was 'dispensing' this at each time point."
Incomplete outcome data (attrition bias) All outcomes	High risk	"Three patients dropped out before completing therapy" (all from group 2) and "data from these subjects were excluded from analyses"
Other bias	Low risk	No other potential bias noted